益生菌辅助治疗慢加急性肝衰竭后肠道菌群及预后观察

Probiotic treatment in acute-on-chronic liver failure:insights into gut microbiota and patient prognosis

目的分析慢加急性肝衰竭(ACLF)患者加用益生菌治疗后的预后情况。方法选取我院84例ACLF患者,随机均分为两组。对照组常规治疗,观察组予以常规^(+)肠道益生菌制剂治疗。观察治疗后患者菌群分布及生存情况。结果观察组治疗前乳酸杆菌、双歧杆菌数量(6.9±0.8)log_(10)nCFU/g、(5.5±0.9)log_(10)nCFU/g,大肠埃希菌、大肠杆菌数量(9.2±1.4)log_(10)nCFU/g、(8.8±0.4)log_(10)nCFU/g;治疗后乳酸杆菌、双歧杆菌数量分别为(8.4±0.6)log_(10)nCFU/g、(9.7±0.8)log_(10)nCFU/g,大肠埃希菌、大肠杆菌数量分别为(5.9±0.5)log_(10)nCFU/g、(6.1±0.4)log_(10)nCFU/g。对照组治疗前乳酸杆菌、双歧杆菌数量分别为(6.8±0.7)log_(10)nCFU/g、(5.4±0.8)log_(10)nCFU/g,大肠埃希菌、大肠杆菌数量分别为(9.0±1.3)log_(10)nCFU/g、(8.7±0.4)log_(10)nCFU/g;治疗后乳酸杆菌、双歧杆菌数量分别为(7.7±0.6)log_(10)nCFU/g、(7.6±0.8)log_(10)nCFU/g,大肠埃希菌、大肠杆菌数量分别为(6.8±0.5)log_(10)nCFU/g、(7.2±0.5)log_(10)nCFU/g。观察组治疗后乳酸、双歧杆菌数量更高,大肠杆菌、埃希菌则低于疗前和对照组(P<0.05)。观察组疗前CD4^(+)、IL-6、IL-10水平分别为(32.8±5.4)%、(87.1±11.2)pg/mL、(31.8±4.4)pg/mL;治疗后CD4^(+)、IL-6、IL-10水平分别为(44.7±2.4)%、(68.1±9.1)pg/mL、(20.5±3.4)pg/mL。对照组治疗前CD4^(+)、IL-6、IL-10水平分别为(34.2±5.6)%、(90.2±9.0)pg/mL、(32.0±4.0)pg/mL;治疗后CD4^(+)、IL-6、IL-10水平分别为(40.0±2.2)%、(75.4±10.2)pg/mL、(26.5±3.0)pg/mL。观察组治疗后CD4^(+)水平显著升高(P<0.05),IL-6、IL-10低于疗前及对照组(P<0.05)。观察组治疗前GGT、ALT、AST、TBil水平分别为(62.3±10.5)U/L、(83.4±11.8)U/L、(98.2±21.0)U/L、(318.6±23.6)μmol/L;治疗后GGT、ALT、AST、TBil水平分别为(49.2±11.0)U/L、(59.6±9.2)U/L、(45.2±9.1)U/L、(158.6±18.6)μmol/L。对照组治疗前GGT、ALT、AST、TBil水平分别为(62.0±11.1)U/L、(84.5±11.5)U/L、(97.5±21.5)U/L、(314.5±20.3)μmol/L;治疗后GGT、ALT、AST、TBil水平分别为(53.7±12.3)U/L、(62.5±10.9)U/L、(48.5±9.2)U/L、(162.8±20.3)μmol/L。上述指标治疗后均低于治疗前(P<0.05)。观察组1年累计生存率为83.33%(35/42),对照组1年累计生存率为78.57%(33/42),两组比较差异无统计学意义差异(P>0.05)。结论对ACLF患者应用益生菌,可抑制患者肠道致病菌生长,提升免疫及肝功能,并改善预后。

Objective To evaluate the impact of probiotic adjuvant therapy on the gut microbiota compostion and clinical prognosis of patients with acute-on-chronic liver failure(ACLF).Methods In our hospital,84 patients diagnosed with ACLF were randomly divided into two groups.The control group received conventional symptomatic treatment,while the observation group was treated with both conventional treatment and gut microbiota.The bacterial distribution,levels of immune factors[CD4^(+),CD8^(+)],inflammatory factors,and liver function indicators[ALT,AST,GGT,TBil]between the two groups were compared.Both groups were followed up for 1 year to observe their survival rates.Results Before treatment,the number of lactobacillus and bifidobacteria in the observation group was(6.9±0.8)log_(10)nCFU/g,and(5.5±0.9)log_(10)nCFU/g,respectively,while the counts of Escherichia coli and coliforms were(9.2±1.4)log_(10)nCFU/g(8.8±0.4)log_(10)nCFU/g,respectively.After treatment,the counts of lactobacilli and bifidobacteria were(8.4±0.6)log_(10)nCFU/g,and(9.7±0.8)log_(10)nCFU/g,respectively,whereas the counts of Escherichia coli and coliforms were(5.9±0.5)log_(10)nCFU/g,and(6.1±0.4)log_(10)nCFU/g,respectively.For the control group,before treatment,the counts of lactobacillus and bifidobacteria were(6.8±0.7)log_(10)nCFU/g and(5.4±0.8)log_(10)nCFU/g,respectively.,The counts of Escherichia coli and coliforms were(9.0±1.3)log_(10)nCFU/g,and(8.7±0.4)log_(10)nCFU/g,respectively.Post-treatment,lactobacilli and bifidobacteria counts were(7.7±0.6)log_(10)nCFU/g,(7.6±0.8)log_(10)nCFU/g,respectively,while Escherichia coli and coliforms counts were(6.8±0.5)log_(10)nCFU/g and(7.2±0.5)log_(10)nCFU/g,respectively.Post-treatment counts of lactobacilli and bifidobacteria in the observation group were significantly higher than their pre-treatment values and those in the control group.Conversely,the counts of Escherichia coli and coliforms were significantly lower post-treatment compared to pre-treatment and those in the control group(P<0.05).Before treatment,the levels of CD4^(+),IL-6 and IL-10 in the observation group were(32.8±5.4)%,(87.1±11.2)pg/mL and(31.8±4.4)pg/mL respectively.After treatment,the levels of GGT,alt,AST and TBil were(49.2±11.0)U/L,(59.6±9.2)U/L,(45.2±9.1)U/L,(158.6±18.6)μmol/L respectively.In the control group,the levels of GGT,ALT,AST and TBil before treatment were(62.04±11.18)U/L,(84.5±11.5)U/L,(97.5±21.5)U/L,(314.5±20.3)U/L,respectivelyμmol/L;After treatment,the levels of GGT,AST,AST and TBil were(53.7±12.3)U/L,(62.5±10.9)U/L,(48.5±9.2)U/L and(162.8±20.3)μmol/L,respectively.After treatment,liver function indices in both groups were significantly lower than their pre-treatment levels in the same group(P<0.05).The 1-year cumulative survival rate was 83.33%(35/42)in the observation group compared to 78.57%(33/42)in the control group.Conclusion The application of probiotics in ACLF patients can suppress the proliferation of harmful intestinal bacteria,enhance immune and liver functions,and potentially lead to better clinical outcomes.